Sunday Aug 19, 2012 interesting cases. Another bright sunny day with blue skies.
Case 1. Samoyed with very high fever.
On Friday evening, the dog transport couple carried in the big Samoyed, recumbent and panting over 1000 times per minute. Like a dog suffering from heat stress. Dr Daniel had told me that this Samoyed was sent to Toa Payoh Vets as he was previously neutered here by Dr Jason and that the previous vet treating him (Vet 2) with a CT scan and other treatments would be releasing the dog to Toa Payoh Vets.
"This dog has a very high temp of 41.7 deg C!" I told the young dog transport couple.
"Perhaps it is due to the traffic jam from Jurong," the couple had to ferry him from Vet 1 and this was rush-hour traffic jam.
At nearly 42 deg C, I seldom see any hope of survival for dogs with heat stress. Furthermore, this dog had fevers of 41 deg C at Vet 2 for the past 2 days. Vet 1's blood tests also showed low platelet counts. Low platelets would mean internal bleeding would not be controllable. Very high fever burns the the internal organs.
"There is no hope for this Samoyed," I said to Dr Daniel as he suggested clipping off the thick woolly coat as part of the cooling measures. Also to give the anti-fever injections. Vet 2 had given one such injection using paracetamol but the fever returned the next day.
"Bring the dog into the bathroom and shower him with lukewarm water for 5 minutes," I said to Min, to an incredulous look from Dr Daniel. He expected immediate anti-fever treatment, I guessed. The dog transport couple put the dog into a carrier bag and Min showered the dog's body and head for 5 minutes, then dried the dog.
"You may think this is not what the professor taught," I said to Dr Daniel. "But it is an accepted method of treatment for heat stress, to be followed by anti-fever and other IV injections." I guessed Dr Daniel had not seen much heat stress cases and they are uncommon even for me.
"Check the rectal temperature after the hair dryer had dried the Samoyed," I said to Min.
"It is 41.5 degrees," Dr Daniel said.
"Don't expect fast spiral downward temperature," I said. "A gradual lowering of the body temperature is less shocking to the dog's blood system in my opinion. Now, we commence on the anti-fever and IV drips."
Saturday morning at 9 am. I came early to check this Samoyed as he was still alive but recumbent. His temperature was 40.7 but he was no longer panting non-stop. He was in excellent body condition.
So, this would be the 3rd day he had high fever which had not dropped despite treatment. No wonder Vet 1 had quickly referred this dog to Vet 2. Vet 1 was presented with this Samoyed who could not stand on his hind legs and had high fever. Now, I was Vet 3 and if the dog died, it would look bad on me. Owners remember the vet when the dog had died in his practice. No explanations and excuses. A beloved family member died at Toa Payoh Vets and that was what they would remember and told their friends and relatives.
I got the dog outside. He was unable to stand on his hind legs and panted a bit more.
What to do now? My repeat blood test showed what Vet 2 had shown. Anaemia and thrombocytopaenia. What causes this?
"It could be caused by Babesia," I said to Dr Daniel earlier and now to Dr Jason. Such auto-immune reactions are caused by Babesia and there was anaemia and thrombocytopenia to support my intuition. Maybe the Babesia had gone to the brain and spinal area, causing the dog to be paralysed in the hind limbs and having a very high fever not controlled by antbioitics for the last 3 days? I did not expound this hypothesia to the 2 vets as I sometimes don't do that. They are professional qualified vets. "A negative Babesia test from Vet 1, does not mean the Samoyed has no Babesiosis," I said to Dr Daniel. "Then what does it mean if we don't trust this negative test?" he would remark. "A negative test may mean that the blood smear taken did not show the parasites or they would not be abundant." I had my theory that the Babesia could be inside the nervous system.
"Did you read Vet 1's report saying that a blood smear showed no Babesia?" Dr Daniel had informed me yesterday. Now Dr Jason said, "Boss, Vet 1's blood test said no Babesia."
As the fever would shoot up again, I asked Dr Jason to inject imidazole at 70% of the calculated dose SC. He was on duty. A 100% may be too strong.
Sunday morning. The temperature was less than 40 deg. As I am typing this case from the lst floor of Hotel Panorama in Hong Kong, I don't have the exact figures.
Monday morning. From the HK Airport, I messaged Dr Daniel for the temp. It was around 38.5 and so it seemed that either I was lucky as the overall treatment had worked or imidazole was the drug that was effective. I had also instructed Min to give doxyclycline on Saturday too.
In private practice, the owner only wants to see his or her dog alive and so, understanding and co-relating clinical signs are much more important than lab tests. Tbis could be a case of Babesiosis based on next day recovery after injection of imidazole. It could be that the dog was on the way to recovery. Whatever the reason, the dog was alive and that was what counted to the owner.
Case 2 and 3. Skin disease of a Shih Tzu with itchy paws. Case of a Westie with black irritating skin behind ears, neck and lower body. Both cases had recovered after treatment by me and so the owners came back to Toa Payoh Vets for the vaccinations after receiving my vaccination reminder cards. Performance counts again. Not every skin disease cases can be cured. Just these two examples which I show-cased to Dr Daniel.
Tuesday, August 21, 2012
1049. Follow up to Blog No.1047: Beijing dwarf hamster with toe tumour
EMAIL TO DR SING DATED AUG 19, 2012
Hi Dr Sing
Thank you so much for your quick reply. I will approach a vet who can help me with my hamster's toe.
You mentioned that the high risk lies with the anaesthesia, how much/long of those can be applied to ensure that it will not harm my hamster?
Again, thanks very much!
XXX
EMAIL FROM DR SING DATED AUG21, 2012
The risk of anaesthesia is high in the older dwarf hamster compared to a younger one.
Much depends on the experience of the hamster vet and the method of anaesthesia being used. If the vet uses isoflurane gas, it depends on the methods used, based on size of tumour and time taken to operate and/or stitch up. Therefore it is hard to let you know how much and how long.
In my experience, this tumour, if it has a stalk, will take 2 seconds to cut it off and therefore anaesthesia by 5% isoflurane gas in a container and not using gas mask is around <60 an="an" anaesthesia.="anaesthesia." close="close" depth="depth" do.="do." experienced="experienced" fixed="fixed" formula.="formula." hamster="hamster" is="is" know="know" no="no" observation="observation" of="of" on="on" p="p" seconds="seconds" the="the" there="there" to="to" vet="vet" what="what" will="will" with="with">
Sunday, August 19, 2012
1048. Canine distemper kills dogs in Pulau Ubin, Singapore
Aug 19, 2012
Pulau Ubin is an island very near to Singapore. Many Singaporeans take a boat to go there for a holiday. Sometimes they bring their dogs along. Yesterday, there was a Straits Times Report saying that some stray dogs that had died in Pulau Ubin recently. The AVA issued a report saying that autopsy report of one dog revealed that it had died from Canine distemper viral infection.
No info on the presentation signs of the dead dogs in Pulau Ubin or the dog that had been autopsied.
Vaccination does prevent canine distemper but few Singapore owners do regular yearly vaccination after puppy hood.
I had seen a few cases of Singapore dogs with fits. One of the reasons could be distemper viral infections of the brain. Check and if the foot pads are hard, it is possible that the dog had previous exposure to distemper virus and develop fits.
Many well-read dog owners surfed the internet and accepted the advices that their dogs should not be vaccinated after the puppy vaccinations or only once in 3 years or only after checking the antibodies. A group would say that yearly vaccination is not good for the dog. So they don't vaccinate as they believe in the internet group.
In Singapore, the vaccines are combined vaccines and those recommended for 3-yearly vaccinations are not single vaccines like just parvo virus or distemper virus vaccines. Therefore, a little bit of internet knowledge puts the pet dog at risk of getting diseases.
Pulau Ubin is an island very near to Singapore. Many Singaporeans take a boat to go there for a holiday. Sometimes they bring their dogs along. Yesterday, there was a Straits Times Report saying that some stray dogs that had died in Pulau Ubin recently. The AVA issued a report saying that autopsy report of one dog revealed that it had died from Canine distemper viral infection.
No info on the presentation signs of the dead dogs in Pulau Ubin or the dog that had been autopsied.
Vaccination does prevent canine distemper but few Singapore owners do regular yearly vaccination after puppy hood.
I had seen a few cases of Singapore dogs with fits. One of the reasons could be distemper viral infections of the brain. Check and if the foot pads are hard, it is possible that the dog had previous exposure to distemper virus and develop fits.
Many well-read dog owners surfed the internet and accepted the advices that their dogs should not be vaccinated after the puppy vaccinations or only once in 3 years or only after checking the antibodies. A group would say that yearly vaccination is not good for the dog. So they don't vaccinate as they believe in the internet group.
In Singapore, the vaccines are combined vaccines and those recommended for 3-yearly vaccinations are not single vaccines like just parvo virus or distemper virus vaccines. Therefore, a little bit of internet knowledge puts the pet dog at risk of getting diseases.
Saturday, August 18, 2012
1047. Dwarf hamster with tumour/wart from Beijing
Hello Dr Sing,
Thank you for sharing priceless info regarding hamster's condition
on the website. I found you on this site and I'm relieved to know that
there is a possibility to address the condition.(http://www.
20090122Hamster_Roborovski_
I'm writing from Beijing and I seek some advise regarding a growth
on my hamster which I now know is called a wart. My hamster is 2+ years
old and he had this wart growing on the side of his toe since January
this year. Occasionally there is pimple-like 'head' that pokes up,
and I have tried to extracted it myself. We also did consulted a vet and
she content is skin cells & sebum related.
The wart seemed to have steadied in size, but the pimple-like thing would come back after we extracted it.
I've attached a picture of the wart, and the size of it. Please have a look.
I would like to know if its possible to surgically have this removed safely - cut off at wart stalk?
Will there be a lot of bleeding and is it high risks?
I understand that we have to put him under gas isofluorane.
I appreciate your time and advise, and look forward to hear from
you regarding this matter as I will talk to my local vet to have this
administered.
I go to an international vet, but hamsters are not common patients
here. So I would like to be informed and perhaps refer my local vet to
your website for references as well.
Thank you in advance and I really hope to hear from you soon.
Regards,
| |||
| |||
Surgical excision under anaesthesia is the solution.
1. If there is a stalk attached to the skin, the vet will just cut off the stalk, apply potassium permanganate powder to control the bleeding or apply pressure bandage.
2. If there is no stalk, there will be a big piece of skin cut off, exposing the bone, muscles, ligaments and tendons. If the wound is <5mm after="after" be="be" br="br" cared="cared" for="for" infection.="infection." it="it" needs="needs" prevent="prevent" surgery="surgery" to="to" well="well">3. If there is no stalk and the tumour has invaded deep into the bones, then amputation of the 5th digit + tumour will be the solution. 6/0 stitching may be needed to close the skin wound.
4. Electro-excision, using electricity is an excellent procedure for this case. Electro- excision controls the bleeding.
Overall, the surgery is low risk and is done in 2 seconds. The anaesthesia is the high risk in old hamsters. The bleeding in this surgery usually does not kill the hamster as the bleeding can be controlled. You may need to locate a vet who is comfortable in performing hamster surgery.
Please let me know the good news after surgery.
Blogger.com has some software bugs as the above 2 images were uploaded in the correct position but appears in an abnormal position
The article is at:
http://www.bekindtopets.com/animals/20081130Hamster_Anaesthesia_Surgery_ToaPayohVets.htm
Friday, August 17, 2012
1046. Female poodle, 4 years with mast cell tumour
"The dog had a lump on the junction of the upper and lower lip on the right side of the mouth. The owner went to Vet 1. He gave some medication. But the lump grows bigger," the friend of the Pom owner said to me. "It is just an abscess. An abscess. Just squeeze it will do." This friend had operated a pet shop before and was now thinking of doing a coffee business in Hainan where his ancestors lived. This young man had given up operating a pet shop and grooming business. He was looking for other ventures.
I palpated the lump on the right lip commissure. It was 8 mm x 6 mm x 6 mm and was firm. "It is not an abscess," I said. " It is a tumour. That is why Vet 1's medication did not work."
Dr Daniel excised the lump using electro-excision and anaesthesia. He stitched up the wound. Then he sent it to the lab for histopathology, after seeking the owner's permission.
It was a mast cell tumour, with some mitotic figures seen. In other words, a malignant tumour. It was likely that the tumour would spread or grow and the owner was informed.
I palpated the lump on the right lip commissure. It was 8 mm x 6 mm x 6 mm and was firm. "It is not an abscess," I said. " It is a tumour. That is why Vet 1's medication did not work."
Dr Daniel excised the lump using electro-excision and anaesthesia. He stitched up the wound. Then he sent it to the lab for histopathology, after seeking the owner's permission.
It was a mast cell tumour, with some mitotic figures seen. In other words, a malignant tumour. It was likely that the tumour would spread or grow and the owner was informed.
1045. The vet "suspects pyometra"
A vomiting female dog. Gastritis or closed pyometra?
Miniature Schnauzer, Female, 8 years, not spayed. An old client of mine but I had not seen the dog for the past 7 years since the puppy vaccination. This is a common situation as the owner might have gone to other vets or just left the dog alone.
August 11, 2012
According to Vet 1's medical record,
Presented for vomting several times, abdominal disension was notes and "suspect pyo" was recorded. Blood test was recorded as the total white cell count and neutrophils as "moderately" increased. Advised spay.
The dog was warded for 3 days. Vomiting disappeared on the 3rd day and the owner (Sister 1) wanted to take the dog home on August 14.
August 15, 2012
I was at work in the evening of August 15 and saw Sister 1 with the dog. She said: "My dog is still vomiting." I checked the records and examined the dog. I put her on the consultation table, palpated the swollen abdomen.
The dog gave a yelp as I palpated. "There is a swollen abdomen which is also painful," I said. "The total white cells of 22.4 (normal 6-17) is high. The neutrophils are 96.3% which indicated a bacterial infection as normally they are around 70%. Based on the findings, this dog is suffering from closed pyometra. An X-ray is not needed unless you want it done."
However Vet 1 said an X-ray would rule out any foreign bodies inside the stomach or intestines as the one of the owners (Sister 2) had said that the dog ate some things.
August 16, 2012"How's the X-ray?" I asked Vet 1. "Does it show pyometra?"
"There is a lot of gas," Vet 1 did not think there was pyometra. "In any case, the owners agreed to the spay."
I saw Sister 1 in the evening at around 7.30 pm. She said: "Now the dog is eating and there is no vomiting, it will be better for the operation tomorrow since it is already late."
"We can still do surgery even at 8 pm," I said.
August 17, 2012The dog was operated. The dog's uterus was full of pus. So far, so good today August 17, 2012. The dog was on her chest and looking around. If vomiting returns, this will be bad news as the kidneys could have been severely damaged.
Conclusion
Time is of the essence in closed pyometra cases as toxins are being absorbed into the blood stream from the swollen uterus. The antibiotics given killed some bacteria and stopped the dog vomiting. So Sister 1 wanted the dog home.
But the toxins are not expelled as the cervix has closed. So the dog starts vomiting again. Toxins damage the kidneys and liver if the owners delay surgery further. Some older generation would not want surgery till the dog collapses.
Owners need to be properly educated. "Vet 1 says 'suspect pyometra'", Sister 1 remarked. Therefore, since the dog had stopped vomiting on Day 3, she wanted the dog home. X-rays or ultrasound should be advised and done during the 3 days of hospitalisation. The vet must be spot on in his or her diagnosis of closed pyometra based on history of heat around 6 months ago in around December 2011, (in this case, Sister 3 said the heat was in Feb or March 2012 throwing Vet 1 off track and thinking of gastroenteritis.)
VOMITING
An older unspayed female dog.
A swollen painful abdomen
A high total white cell count with high neutrophils and low platelet count
are clues to a tentative diagnosis of CLOSED pyometra. It is an emergency.
This case's blood test results are:
Total white cell count 22.4 (6-17)
N=96.3% Abs = 21.7
L=3.6% Abs = 0.81
M=0.1% Abs = 0.02
E=0.1% Abs = 0.02
B=0% Abs = 0.00
Platelets 107 (200-500). No platelet clumps but few giant platelets present.
The vet must not confuse the owner with the wording "suspect pyo." as owners don't know the severity of this closed pyometra situation which could kill the dog if surgery is delayed.
1044. The young generations prefers emails and sms
Hi Dr. Sing,
It has been awhile since I last emailed you. A lot has changed in the past few months and ........ has ceased operations due to a lack of clients. I did however, see that you are employing vet techs in your clinic. I was wondering if I am eligible to apply? I have extensive experience working with animals. Attached is my resume, maybe you can have a look and tell me what you think?
On Aug 15, 2012, at 9:21 AM, Kong Yuen Sing wrote:
Pl come for an interview at 9.30 am on weekdays this week as regards vet tech job or other collaborations. My phone is 9668 6468. Thanks.
Pl come for an interview at 9.30 am on weekdays this week as regards vet tech job or other collaborations. My phone is 9668 6468. Thanks.
On Wed, Aug 15, 2012 at 2:32 PM, ...@gmail.com> wrote:
On 16 Aug, 2012, at 5:03 AM, Kong Yuen Sing <99pups@gmail.com> wrote:
Pl let me know what pay you expect and what hours you will put in.
On Thu, Aug 16, 2012 at 10:28 AM, ...@gmail.com> wrote:
EMAIL FROM DR SING DATED AUGUST 17, 2012
If you are free, it is better to have an interview. Working "full time" and "any hours" has different meanings to different people. So, it is not possible to market yourself just via emails. Your resume shows that you don't have "vet tech" experience but there are other positions in Toa Payoh Vets.
Unfortunately, interviews cannot be avoided if you want no misunderstandings. A person can be worth every of the $2,500 salary if he or she can contribute and earn much more for the company with new ideas and concepts that vitalise a company and increases its revenue. Just talking about $2,500 salary expected for a "vet technician" position just does not have any meaning unless experiences, testimonials, duties and responsibilities and performance can be known.
Thank you Dr Sing for the opportunity. I would like to know what the average pay is like as well as I have a sick father to support at home. To be honest, if it is too low I wouldn't want to waste your time as well. I hope you understand.
On 16 Aug, 2012, at 5:03 AM, Kong Yuen Sing <99pups@gmail.com> wrote:
Pl let me know what pay you expect and what hours you will put in.
On Thu, Aug 16, 2012 at 10:28 AM, ...@gmail.com> wrote:
Hi Dr Sing,I am intending to work full time, any hours. My expected is salary is $2500 per month, but I really don't know what is the market norm. Do correct me of you think I'm expecting too much.
EMAIL FROM DR SING DATED AUGUST 17, 2012
If you are free, it is better to have an interview. Working "full time" and "any hours" has different meanings to different people. So, it is not possible to market yourself just via emails. Your resume shows that you don't have "vet tech" experience but there are other positions in Toa Payoh Vets.
Unfortunately, interviews cannot be avoided if you want no misunderstandings. A person can be worth every of the $2,500 salary if he or she can contribute and earn much more for the company with new ideas and concepts that vitalise a company and increases its revenue. Just talking about $2,500 salary expected for a "vet technician" position just does not have any meaning unless experiences, testimonials, duties and responsibilities and performance can be known.
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